Some osteoporosis medications help build bone or rebuild bone strength, whereas others help slow down bone loss.
Osteoporosis medications that help build bone or increase bone strength are generally given for up to 1-2 years. They include:
- Forteo (teriparatide): Administered as a subcutaneous injection once a day
- Tymlos (abaloparatide): Administered as subcutaneous injection once a day
- Evenity (romosozumab): Administered as subcutaneous injection once a month
What is osteoporosis?
It is estimated that approximately 10 million men and women in the United States suffer from osteoporosis. Although it is more commonly associated with women (postmenopausal), it can also be found in men.
What are the main types of osteoporosis?
- Primary osteoporosis:
- Commonly associated with aging and sex hormone deficiency
- Results from the continuous deterioration of bone trabeculae due to aging
- In postmenopausal women, a reduction of estrogen production may result in significant increase in bone loss
- In men, sex-hormone-binding globulin inactivates testosterone and estrogen with age, contributing to the decrease in bone mineral density
- Secondary osteoporosis
- Commonly associated with underlying diseases and medications
- Glucocorticoids are common medications linked to drug-induced osteoporosis
- For men, excessive alcohol consumption, glucocorticoid use, hypogonadism, and receiving androgen-deprivation therapy for prostate cancer are associated with osteoporosis
- For women, hypercalciuria, malabsorption of calcium, hyperparathyroidism, vitamin D deficiency, hyperthyroidism, Cushing’s disease, and hypocalciuric hypercalcemia are associated with osteoporosis
- For both men and women, disorders of calcium metabolism and hyperparathyroidism contribute to 78% of secondary osteoporosis cases.
What causes osteoporosis?
Most adults reach peak bone mass at about age 30, after which they begin to lose bone mass steadily. Although this is highly dependent on genetics, factors that can affect bone mass include nutrition, exercise, certain diseases, and medications:
Your bones are constantly undergoing a repairing process through continuous resorption by osteoclasts and replaced with new bone made by osteoblasts. This process allows for the maintenance of bone strength and repair. An imbalance in this remodeling activity, leading to resorption exceeding formation, may result in changes in this process.
In addition, hormones such as estrogen and testosterone have a significant effect on bone remodeling primarily by inhibiting bone breakdown. Due to the depletion of these hormones after menopause, the rate of bone removal speeds up, and bone formation is unable to keep pace, resulting in bone loss and ultimately weakened, brittle bones.
Moreover, remodeling cytokines such as receptor activator of the nuclear factor kappa-B ligand (RANKL), produced by osteoblasts (bone-forming cells) that bind to RANK receptors on osteoclasts (bone-degrading cells), lead to the activation and maturation of osteoclasts and culminate in bone resorption.
How is osteoporosis diagnosed?
Osteoporosis often goes undiagnosed until it manifests as a low-trauma fracture. Since there are usually no noticeable symptoms, the United States Preventive Services Task Force recommends bone mineral density (BMD) screening for all women ages 65 and older.
Diagnosis of osteoporosis is primarily determined by measuring BMD using noninvasive dual-energy X-ray absorptiometry. The resulting T-scores that are used to interpret BMD and correlate results with fracture risk. Low BMD (or a highly negative T-score) is strongly correlated with high fracture risk.
The National Osteoporosis Foundation recommends monitoring BMD 1-2 years after initiation of treatment and every 2 years thereafter.
|−1.0 and above||Normal|
|−1.0 to −2.5||Osteopenia|
|−2.5 and lower||Osteoporosis|
|−2.5 and lower with one or more fragility fractures||Severe osteoporosis|
Another diagnostic instrument is the fracture risk assessment tool, which considers risk factors to predict the 10-year probability of hip fracture and other major osteoporotic fractures. Risk factors include:
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How is osteoporosis treated?
Unfortunately, osteoporosis cannot be cured completely. However, medications and lifestyle changes can slow or stop the progression of the disease and prevent further complications.
- Antiresorptive: These medications primarily reduce the rate of bone resorption (breaking down of the bones):
- Estrogen agonist/antagonists or selective estrogen receptor modulators
- Hormonal therapy
- Testosterone therapy
- Miacalcin (calcitonin)
- Receptor activator of the nuclear factor kappa-B ligand inhibitor
- Prolia and Xgeva (denosumab)
- Anabolic or parathyroid hormone analogues: These medications primarily increase bone formation:
- Forteo (teriparatide)
- Tymlos (abaloparatide)
- Evenity (romosozumab)
According the American Association of Clinical Endocrinologists and American College of Endocrinology guidelines:
- First-line treatment for most postmenopausal osteoporosis patients at a high risk of fracture includes alendronate, risedronate, zoledronic acid, and denosumab
- Treatment for those who cannot use oral therapy and are at a high risk of fracture includes teriparatide, denosumab, or zoledronic acid
- Adequate dietary calcium and vitamin D intake:
- Daily dietary calcium intake should be limited to:
- Men ages 50-70: 1,000 mg
- Men ages 71 and older: 1,200 mg
- Women ages 51 and older: 1,200 mg
- Daily vitamin D intake should be limited to:
- Men and women ages 51-70: 600 IU
- Men and women over 70: 800 IU
- Daily dietary calcium intake should be limited to:
- Weight-bearing exercises
- Smoking cessation
- Limitation of alcohol and caffeine consumption
- Fall-prevention techniques
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Osteoporosis: A Review of Treatment Options. NIH: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768298/
Brunilda Nazario. Osteoporosis Medications. WebMD: https://www.webmd.com/osteoporosis/what-to-know-about-osteoporosis-meds
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